American Thoracic Society News Tips for May

AMERICAN THORACIC SOCIETY NEWS TIPS FOR MAY

LOW SOCIOECONOMIC STATUS SERIOUSLY AFFECTS OUTCOME IN CYSTIC FIBROSIS PATIENTS

Medically indigent children with cystic fibrosis (CF), although they have as many visits to the doctor as the non-indigent, suffer more serious consequences from their disease than does the general CF population. Looking at data from 1986 to 1994 from the National Cystic Fibrosis Registry, researchers found 20,390 CF-affected young persons who were under age 20 and had all insurance data recorded.

The adjusted risk of death for the 1,894 patients (9.3 percent) on Medicaid was 3.66 times higher than for those not receiving Medicaid benefits. Also, they were 2.19 times more likely to be below the 5th percentile for weight and 2.22 times more likely to be below the 5th percentile for height. Rather than access to care, which was the same for both sets of patients, the researchers point out that the adverse effects on health for indigent CF patients were probably caused by nutritional inadequacies, greater exposure to indoor and outdoor pollution, more exposure to environmental tobacco smoke, and contracting additional respiratory viral infections, especially respiratory syncytial virus. They said they could readily identify the poor as a group of patients at risk for adverse outcomes, with potential need for more intense standard treatment. The research appears in the May issue of the American Journal of Respiratory and Critical Care Medicine.

PRETEEN GIRLS WHO BECOME OVERWEIGHT VERY LIKELY TO DEVELOP NEW ASTHMA SYMPTOMS

Females who become overweight or obese between the ages of 6 and 11 were seven times more likely to develop new asthma symptoms at age 11 and 13 than girls who did not become heavier. Participants in the study were 1,245 children enrolled at birth between 1980 and 1984 in the Tucson Children's Respiratory Study. Of the 339 girls who had anthropometric measurements taken at age 6, 15 percent were overweight and over 8 percent were obese. At age 11, more than 10 percent were overweight and 9 percent were obese.

The authors say their results argue against the hypothesis that overweight status can cause asthma directly because similar effects would be expected in both sexes if that concept were true. Rather, they note that obesity appears to influence female sex hormones and that this, in turn, alters asthma risk. For example, they found their strongest association between overweight status and asthma risk among girls whose puberty started before age 11. Obesity is a strong risk factor for early onset of puberty and early menarche in girls. Obesity also affects lung function test results. They said girls using an asthma peak flow meter who also were obese showed a higher prevalence of daily peak airflow variation. The research appears in the May issue of the American Journal of Respiratory and Critical Care Medicine.

CUTTING UNSCHEDULED VISITS TO THE EMERGENCY ROOM FOR SEVERE ASTHMA EXACERBATIONS

Canadian researchers say the best method to manage the asthma after an unscheduled visit to the emergency room or outpatient clinic for an acute exacerbation, is to provide patients with an action plan, teach them proper inhaler techniques, and provide them with access to a 12-month educational intervention aimed at improving their self-efficacy in controlling their disease. By looking at various approaches during their controlled study, Canadian investigators were able to demonstrate a marked decrease in the number of unscheduled visits to the emergency room or outpatient clinic for acute asthma exacerbations in a group of knowledgeable patients during the second half of their study.

Of the 98 persons who completed the study, a control group of 35 received the usual treatment (Group C); a group of 30 were taught how to use an inhaler and given an asthma action plan by a physician on duty (Group LE); and a final group of 33 also received, in addition, a structured educational program together with the inhaler use instruction and asthma action plan (Group SE). Their one-year educational program emphasized the individual's capacity to manage his or her asthma exacerbations. After six months, the percentage of patient visits to the outpatient clinic and emergency department from the structured educational group (Group SE) became much lower than that for the other two groups. Also, their knowledge level was significantly higher; in addition, at 12 months, a much higher percentage of the third group were using their asthma self-action plan. The study appears in the May issue of the American Journal of Respiratory and Critical Care Medicine.

For the complete text of these articles, please see the ATS Journal Online Website at http://www.atsjournals.org. For the contact information of a specific investigator, to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the monthly mailing list, contact Christina Shepherd at (212) 315-6441, by fax at (212) 315-6456, or by e-mail at [email protected].

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